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A 75-year-old man underwent elective preoperative transesophageal echocardiography (TOE) in view of worsening symptomatic severe mitral regurgitation (MR). Intubation was uneventful but mid-oesophageal images were unexpectedly of poor quality. Prolapse of the P2 scallop of the posterior mitral valve (MV) was confirmed using two-dimensional and three-dimensional TOE (figure 1A,B, online supplementary video 1 and 2) with severe anteriorly directed MR (figure 1C,D, online supplementary video 3 and 4). However, transgastric views could not be obtained due to resistance on advancing the probe beyond 40 cm and the procedure was abandoned. …
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